Pay reasonable costs of a gym/swim program to assist a worker in the rehabilitation of a work related injury or illness and to transition to independence or a self managed exercise program

Premises should provide evidence of current public liability insurance for a gym and/or pool of at least $5 million

Definition: gym and swim programs are structured exercise programs that are developed and monitored by a healthcare professional for a worker to perform independently in a gym and/or pool for the purpose of rehabilitation. Programs are for a fixed duration generally 3 months.

Will pay when :

It will assist the worker achieve specific work-related and functional goals and transition to independence or a self managed program

Written plan includes specific work related and functional goals and at least one current baseline standardised functional outcome measure

The plan includes details of set up, monitoring and evaluating the program

The program is identified as reasonable and necessary.

Will consider an extension when the written plan includes an evaluation of the previous program and reason why the worker requires an additional program, also includes baseline and serial outcome measures

Will consider payment for a program longer than 3 months in exceptional circumstances – where worker has a complex injury such as spinal cord injury, acquired brain injury, crush injury, multiple orthopaedic injuries, amputations.

Will not pay

if there is not a written plan, that are not related to rehabilitation,

if the program has a primary focus on general fitness

for personal trainers

for swimming lessons

clothing

more than one program at one time

Motor Accidents Authority NSW

pay for services which are considered reasonable and necessary

consider the following when making a decision

relationship of the service to the accident

benefit to the claimant –how will the outcome of the service progress/maintain the claimants recovery/management; what would be the outcome of not providing the service; is there sufficient documentation to support that the requested service will be of benefit to the claimant

appropriateness of the service – is the service consistent with the current medical or rehabilitation management; is there a similar service currently provided; what related services

appropriateness of the provider

cost considerations

reasonable and necessary criteria

is there sufficient evidence that the services relate to the injuries sustained

what benefit to the client will be gained by the service

what will be the outcome of not providing the service

is there sufficient documentation that the requested service will be of benefit to the claimant

is the proposed service appropriate for the injuries?

is there a similar service currently provided

what related services have been provided in the past and what was the outcome

is the service in keeping with current best practise/clinical guidelines

is there good evidence the service is not effective

are there any contradictions for the service

what are the goals and expected outcomes

TAC Victoria

TAC can fund the reasonable cost of an independent fixed term gym or swim program for the purpose of rehabilitation.

TAC recognise that a client may benefit from a fixed term gymnasium or swimming program where it:

Will assist client to transition from provider based treatment to a self managed program

Once the clients condition stabilises the programs becomes maintenance and client is responsible for future programs. The client will be reimbursed only after it is confirmed the client attends regularly.

Need

Evidence of functional goals

Current clinical status and baseline outcome measures

Outcome measures throughout the program

Confirmation the client understands how to safely perform the exercises

Evidence the program will be monitored on a regular basis

Extension of programs will only be considered in exceptional circumstances where:

The request includes the current rehabilitation goals and time lines

Method and frequency of evaluation

TAC will not fund:

Extra facilities eg spa. Sauna

Personal trainers

A gym that offers extra services and the client chooses this in preference to a standard gym

A maintenance program

Gym clothing

Gym programs that are not clinically justified

Treatment, services or equipment that is not evidence based or is not safe

Request form – asks – Do your outcome measures suggest the client is in – maintenance , rehabilitation or unsure

Comcare

SRCA 1988

Request form includes questions such as:

Have you previously attended a gym – facility details, when ?

How is the gym program related to the accepted condition?

Supply a detailed program outline

Can the employee perform the required exercises at home – if not why not?

If the employee is currently out of work how will this program facilitate a return to work?

About CLIK

The Consolidated Library of Information and Knowledge (CLIK) contains all the legislative, policy and reference material used by DVA staff in providing service to the clients of the Department of Veterans' Affairs.

Rehabilitation

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